Direct CT Venography in ESRD Patients: Technical Experience and Findings

Abstract

Objective: The aims of this study were to describe direct computed tomography venography (CTV) for upper limb venous system evaluation and to report on findings in end-stage renal disease (ESRD) patients.Materials and Methods: Direct CTV was performed using a 64-multidetector computed tomography (MDCT) scanner with simultaneous injection of diluted iodinated contrast (IC); 1:4 at both elbows and 2-phase scanning namely, the direct venous, and the arterial phases. The findings in ESRD patients evaluated between November 2013 and March 2019 were retrospectively reviewed.Results: Forty CTV examinations (600 venous segments) were performed and the volume of IC used per patient was 38 mL. Number of lesions found in a patient ranged from 1 to 6 and the majority had 1 to 3 lesions (30/38 patients). Stenosis and thrombosis were the two most common findings (112/600) and were equally prevalent. The three most common sites of steno-occlusive complications were the brachiocephalic vein (29 lesions), the internal jugular vein (25 lesions), and the subclavian vein (16 lesions). The most common site of stenosis was the brachiocephalic vein (18 lesions), whereas the most common site of thrombosis was the internal jugular vein (20 lesions). No venous aneurysms or ruptures were found. IC extravasation at the site of injection occurred in one arm in one patient.Conclusion: Direct CTV has the advantage of requiring lower IC volume while maintaining direct visualization of the venous system similar to conventional venography.